Validation of the corticomedullary difference in magnetic resonance imaging-derived apparent diffusion coefficient for kidney fibrosis detection: a cross-sectional study
Validation of the corticomedullary difference in magnetic resonance imaging-derived apparent diffusion coefficient for kidney fibrosis detection: a cross-sectional study
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DOI：
10.1093/ndt/gfy389
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发表时间：
2020-06-01
影响因子：
6.1
通讯作者：
de Seigneux, Sophie
中科院分区：
文献类型：
--
作者：
Berchtold, Lena;Friedli, Iris;de Seigneux, Sophie
背景肾皮质间质纤维化（IF）是肾脏预后的高度预测，目前通过评估活检来评估。扩散磁共振成像（MRI）是一种很有前途的工具来评估肾脏纤维化通过表观扩散系数（ADC），但遭受个体间的差异。我们最近应用了一种新的MRI协议，允许计算皮质髓质ADC差异（Δ ADC）。在此，我们对164例接受活检的患者进行了Delta ADC纤维化评估的验证，并将其与估计的肾小球滤过率（eGFR）和其他血浆参数进行了比较，以检测纤维化。这项单中心横断面研究纳入了2014年10月至2018年5月期间在日内瓦大学医院肾脏科接受肾活检的164例患者。患者在活检后1周内接受弥散加权成像，T1和T2标测。MRI结果与金标准组织学纤维化评估进行比较。在自体和同种异体移植患者中，绝对皮质ADC或皮质T1值与活检评估的IF相关性较差，而Delta ADC与IF（r=-0.52，P < 0.001）和eGFR（r= 0.37，P < 0.01）高度相关。Δ T1与IF和eGFR的相关性较低，但具有显著性，而T2与IF和eGFR均不相关。Delta ADC、Delta T1和eGFR与肾纤维化独立相关，三者联合检测广泛纤维化具有良好的特异性。Δ ADC值与IF的相关性优于绝对皮质或髓质ADC值。Δ ADC、Δ T1和eGFR与IF独立相关，可用于识别广泛IF患者。
Background. Kidney cortical interstitial fibrosis (IF) is highly predictive of renal prognosis and is currently assessed by the evaluation of a biopsy. Diffusion magnetic resonance imaging (MRI) is a promising tool to evaluate kidney fibrosis via the apparent diffusion coefficient (ADC), but suffers from inter-individual variability. We recently applied a novel MRI protocol to allow calculation of the corticomedullary ADC difference (Delta ADC). We here present the validation of Delta ADC for fibrosis assessment in a cohort of 164 patients undergoing biopsy and compare it with estimated glomerular filtration rate (eGFR) and other plasmatic parameters for the detection of fibrosis.Methods. This monocentric cross-sectional study included 164 patients undergoing renal biopsy at the Nephrology Department of the University Hospital of Geneva between October 2014 and May 2018. Patients underwent diffusion-weighted imaging, and T1 and T2 mappings, within 1 week after biopsy. MRI results were compared with gold standard histology for fibrosis assessment.Results. Absolute cortical ADC or cortical T1 values correlated poorly to IF assessed by the biopsy, whereas Delta ADC was highly correlated to IF (r= -0.52, P < 0.001) and eGFR (r= 037, P < 0.01), in both native and allograft patients. Delta T1 displayed a lower, but significant, correlation to IF and eGFR, whereas T2 did not correlate to IF nor to eGFR. Delta ADC, Delta T1 and eGFR were independently associated with kidney fibrosis, and their combination allowed detection of extensive fibrosis with good specificity.Conclusion. Delta ADC is better correlated to IF than absolute cortical or medullary ADC values. Delta ADC, Delta T1 and eGFR are independently associated to IF and allow the identification of patients with extensive IF.